This government document is issued by Council on Criminal Justice and Behavioral Health (CCJBH) for use in California
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https://www.google.com/url?client=internal-element-cse&cx=001779225245372747843:jlj8wskj2ii&q=https://www.cdcr.ca.gov/bph/wp-content/uploads/sites/161/2019/08/BPH-Form-1073-R.pdf&sa=U&ved=2ahUKEwjh9dPMzaXyAhWSzosKHfLHAA8QFjAFegQICBAB&usg=AOvVaw04NYnK_ss6faO7Xh1uuBA6